19 NOVEMBER 2018

Fighter Safety and the Nevada State Athletic Commission

By Thomas Hauser

Every now and then, a chain of events reveals rot within a respected institution.

In recent years, the Nevada State Athletic Commission has been wrestling with a series of high-profile medical incidents. Through it all, Flip Homansky has been the commission's leading proponent of proper medical care for fighters. Homansky was appointed to the commission five years ago. Prior to that, he served as a ringside physician for two decades.

Homansky pushed for mandatory MRI testing and was in the forefront of the development of the NSAC's steroid and HIV testing policies. His medical expertise combined with his advocacy of good medical care makes him ideally suited for a commission that is dedicated to high medical standards. It also makes him a liability to those who think that properly caring for fighters costs too much and interferes with matchmaking.

Boxing is systemically corrupt. When something in the sweet science doesn't look right, most likely it isn't. Right now, something doesn't look right in Nevada.

On November 4th, Nevada governor Kenny Guinn announced the removal of Homansky from the NSAC. His replacement, Theodore "T.J." Day, is chairman of a Reno-based private-investment firm. Over the years, Day has been a generous contributor to the Republican Party and its candidates. The Las Vegas Sun has called him one of "the top individual soft money donors in Nevada."

It's possible that Day will turn out to be a marvelous commissioner who learns the ins and outs of boxing and fights resolutely for high medical standards. However, this is not the time to remove one of the most knowledgeable ring doctors in the United States from the Nevada State Athletic Commission.

From 1933 through 2004, there were ten ring fatalities in Nevada. That's a relatively low number. But since May of this year, four fighters have left the ring in Las Vegas with bleeding in their brain. Leopoldo Gonzalez and William Abelyan survived. Martin Sanchez and Leavander Johnson didn't.

Sanchez was a 26-year-old club fighter from Mexico with 18 wins and 8 losses. He had gone past six rounds only twice in his career. On one of those occasions, he'd been knocked out in round seven. On the other, he lost a unanimous decision to a 2-6-2 fighter.

On July 1, 2005, Sanchez fought Rustam Nugaev at The Orleans in a scheduled ten-round bout. It was his first fight out of Mexico. Sanchez won the early rounds. Then, a minute into round four, he took a glancing blow to the back of the head, turned, walked to a neutral corner, and knelt down, holding the back of his head. There was no count. Referee Kenny Bayless told him, "You got to fight; let's go." After ten seconds on the canvas, Sanchez rose but he was no longer the same fighter. His movement slowed and his punches lost their snap. For the rest of the fight, he took a beating. In round nine, he stopped throwing punches. Finally, two minutes into the round, a left hook put him into the ropes and down for the count.

After the fight, Sanchez sat on his stool for a long time. He did not go to ring center to embrace his opponent. When he finally stood up, it was only for a moment and then he sat down on his stool again. Dr. William Berliner (the lead physician for the night) examined Sanchez in the ring and concluded that he was fine. Chris Tognoni (the commission inspector assigned to the fighter) said later that he was concerned as Sanchez walked to his dressing room because his cornermen seemed to be giving him more than the normal assistance. Promoter Jeff Grmoja later said that Sanchez complained his legs had gone numb. Dr. Jeff Davidson (the #2 physician) then went to the dressing room, examined Sanchez, ordered that he be given a CT-scan, and returned to ringside to watch the final fight. Soon after, Chuck Anzolone (another inspector) noticed that Sanchez was experiencing further loss of control of his legs and called Davidson back to the dressing room. By the time Davidson got there, Sanchez was seizing and his pupils were enlarged. Davidson sent him to him Valley Hospital. Sanchez underwent emergency brain surgery and died the following morning.

In the aftermath of the Sanchez tragedy, NSAC chairman Raymond "Skip" Avansino asked chief deputy attorney general Keith Kizer to "review" the facts surrounding the death. Avansino was very clear and precise in asking "for a review, not an investigation."

On September 6th, Kizer presented his findings at a commission meeting. "As I see this," he said in conclusion, "I don't have any recommendation. I don't see any way to improve." Avansino thanked Kizer for doing "a commendable job" and commissioner Tony Alamo Jr weighed in with the declaration, "We did everything right, and unfortunately this poor man passed away."

The primary responsibility of the Nevada State Athletic Commission is not to protect itself. It's to properly regulate the sport of boxing. When someone riding on a municipal transit system is killed in an accident, the government agency that operates the system conducts a full and honest inquiry into the cause of death. That's the best way to improve operating procedures and employee performance.

Keith Kizer is a capable attorney, but one wonders whether his "review" assignment was to search out the truth regardless of consequences. To some, his report to the NSAC seemed like a brief prepared by defense counsel on behalf of the commission and its personnel, not a serious look at the facts.

For starters, Sanchez's NSAC medical forms were not fully filled out and were never signed by the fighter. There are also questions regarding actions taken and not taken during and immediately following the fight.

Dr. Berliner acknowledged at the September 6th meeting that neither he nor Dr. Davidson (who was assigned to Sanchez's corner) saw any need to examine the fighter between rounds. Given Sanchez's strange behavior after he was hit on the back of the head in round four and the subsequent deterioration of the fighter's skills, that judgment is open to question. Moreover, since neither Berliner nor Davidson speaks Spanish, did either one of them really know what Sanchez was saying in the ring after the fight?

There are also issues regarding the timeline for Sanchez complaining about numbness in his legs, his appearing unfocused and disoriented, his seizing, and being transported to the hospital. Who was told, when were they told, and what were they told? After the decision was made that Sanchez should have a CT-scan, was he at any time not attended to by a paramedic or NSAC physician? And why was Sanchez sent to Valley Hospital instead of a level-1 trauma center such as the University Medical Center or Sunrise Hospital?

The above questions are asked with the benefit of hindsight. But another issue raised (and quickly buried) at the September 6th commission meeting has been a problem in Nevada and elsewhere for a long time.

It's a dirty little secret in boxing that some Mexican fighters are exploited by a system that allows them to step into a boxing ring without the medical safeguards required by law. Sanchez supposedly was given an MRI and other tests in Tijuana on June 29th on his way from Mexico City to Las Vegas.

Maybe he was. But there's a lot of talk these days about phony medicals for fighters who come to the United States from Mexico. Thus, at the September 6th meeting, Flip Homansky declared, "The data from Mexico is very difficult to substantiate. There are mills where one can get a result for an MRI without having taken one. The data that comes from Mexico is at times very suspect."

There are three lawyers on the Nevada State Athletic Commission. Once Homansky made his comment, one might have expected a follow-up question to Keith Kizer along the lines of, "Have you examined the integrity of the pre-fight medicals on Martin Sanchez that were forwarded to the commission?"

Except the question wasn't asked. Instead, Tony Alamo Jr proclaimed, "It's a slippery slope when we start dictating which diagnostic center is worthy." Then the commission moved on to other matters.

Homansky's comments with regard to phony medicals made it clear that he would not sit silently through medical charades in the months ahead. As he himself said, "Every ring death is a blow to the sport. But the greater tragedy is if we don't try to understand what happened and how to prevent it from happening again."

Then came another trauma. On September 17th, IBF lightweight champion Leavander Johnson fought Jesus Chavez in the opening bout of HBO's pay-per-view telecast of a fight card featuring Marco Antonio Barrera versus Robbie Peden at the MGM Grand. Johnson took a beating. On two occasions during the fight, ring doctor Margaret Goodman visited his corner and found him alert with no sign of neurological damage. After the tenth round, she told referee Tony Weeks to keep a close eye on the fighter and not let him take too much more punishment.

Thirty-eight seconds into round eleven, Weeks stopped the fight. Again, Dr. Goodman examined Johnson and found him alert with no sign of neurological damage. On the way back to his dressing room, Johnson began dragging his leg. Goodman was told and instructed Al Capanna (a neurosurgeon) to go to the dressing room and care for the fighter. Capanna immediately accompanied Johnson to the University Medical Center in an ambulance. Forty minutes after first showing neurological symptoms, Johnson was in surgery for treatment of a subdural hematoma. He died five days later.

One can draw distinctions between between the deaths of Martin Sanchez and Leavander Johnson. Dr. Goodman examined Johnson twice between rounds. After the fight, Johnson was alert and responsive and did not linger on his stool. Unlike Sanchez, Johnson spoke English so there was no problem in communication between the fighter and ring doctor. Johnson was not left without a doctor at any time after showing neurological symptoms and he was taken to a level-1 trauma center. Also, there is no question regarding the integrity of Johnson's pre-fight medical tests.

Thus, Jim Lampley, who was HBO's blow-by-blow commentator for Johnson-Chavez, declares, "Some ring tragedies are avoidable; others aren't. If you can't live with Leavander Johnson's death, you ban boxing."

Still, both Martin Sanchez and Leavander Johnson are dead. And on September 23rd, after consulting with Governor Guinn, Avansino announced the formation of an advisory committee on boxer health and safety to review the NSAC's medical guidelines and recommend changes to better protect fighters in the ring.

The committee consists of three former NSAC chairmen (Sig Rogich, Luther Mack, and James Nave), state assemblyman Harvey Munford, and Dr. Charles Ruggeroli (a cardiologist). Rogich has been designated as chairman. The committee's findings are due on or before April 1, 2006.

Meanwhile, in some quarters, there is skepticism. "If the committee is about how to improve fighter safety," asks Allan Scotto, "why is it being chaired by a public relations expert? Why bring back three former commissioners? If they were going to do something about fighter safety, why didn't they do it when they had the power to do it? A cardiologist? With all due respect, when was the last time a fighter died of a heart attack in the ring? Since fighters are dying of subdural hematomas, why is a top-notch neurologist conspicuously excluded from this committee?"

Scotto might have added that Flip Homansky, who would have been an extraordinary asset to the committee, was by-passed in the selection process.

When the committee gets down to brass tacks, it must start with the underlying reality that boxers hurt each other on purpose. Except in rare instances, a fighter doesn't want to seriously injure his opponent. But he does want to knock him unconscious or cut him badly enough that the fight is stopped. Everything that takes place in a boxing ring is based on that premise.

Nevada has several outstanding ring doctors; foremost among them, Margaret Goodman. Goodman has worked fights for eleven years. In May 2004, she was designated as the NSAC's chief ringside physician. That job, when done properly, involves a Herculean effort. Goodman has a private practice as a neurologist but she was available to the commission seven days a week. She was constantly on the phone, reviewing medical reports, studying tapes of fighters, drafting letters, reviewing suspension lists, and talking with commission officials in the performance of a job that wasn't even her livelihood.

However, Goodman found herself fighting an uphill battle and too often was denied the authority to properly care for fighters. On July 26, 2005, she resigned in frustration as chief ringside physician because of the failure of the commission to enforce its own medical rules and regulations. It's fitting that, in her last fight as chief ringside physician, she intervened after ten rounds to stop Wayne McCullough from taking further punishment at the hands of Oscar Larios in a July 16th championship bout.

"I think we need to re-evaluate the system from top to bottom," Goodman said recently. "Maybe we can't find the answer, but it's something that has to be done and done very quickly. We need to re-evaluate the entire way we approach the testing and treatment of boxers. These kids trust their lives to us, and we're failing them."

Discussions with medical personnel and others in the sweet science make it clear that the NSAC advisory committee on boxer health and safety should address the following issues:

(1) Some of Nevada's ring doctors are inadequately trained and have questionable judgment. It's not enough to simply be a doctor and show up on the night of a fight.

(2) The NSAC critiques the performance of referees and judges after each fight. Shouldn't it do the same with ring doctors. For example, there is a widespread perception that, when a fighter is unconscious and seizing in the ring, he should be given oxygen. Yet Jeremy Williams was unconscious for almost three minutes and suffered two seizures in the ring after he was knocked out by Samuel Peter last December, and oxygen wasn't administered. "What's particularly upsetting about that," says Dr. Goodman, "is that I was instructed to not sit down with the doctor in question and discuss the situation with him afterward. So what happens the next time a fighter is unconscious and seizing on the canvas?"

(3) Too often, medical suspensions in Nevada are adjusted to accommodate a particular manager or promoter.

(4) There is a mentality in Nevada and elsewhere that "the show must go on." That's true of both club fights and major bouts. There are a lot of reasons (most of them economic) for allowing a mega-fight to proceed even though problems arise at a fighter's pre-fight physical. But other than Tommy Morrison testing positive for HIV in Las Vegas and Henry Akinwande testing positive for hepatitis in New York, how many times has a major fight been called off by a state athletic commission for medical reasons? Or phrased differently, if Vitali Klitschko hadn't pulled out of his bout against Hasim Rahman, does anyone seriously think that an NSAC doctor would have told him, "Gee, you have a problem with your knee. You can't fight on Saturday night." At a minimum, let's have an honest dialogue on this issue.

(5) At least one NSAC doctor regularly treats and writes prescriptions for unarmed combatants in Nevada in violation of state law.

(6) Certain medical tests are sometimes not given to "protected" fighters in Nevada.

(7) Required pre and post-fight NSAC medical forms are often not filled out properly or signed by the fighter.

(8) The NSAC does nothing to regulate gyms. That means Al Cole, who has been placed on administrative suspension by the New York State Athletic Commission because of his deteriorating skills, can work as a sparring partner in Nevada and get punched in the head on a regular basis by Samuel Peter.

(9) The NSAC often licenses unfit fighters and allows mismatches to take place. These fights might not lead directly to death, but they're responsible for much of the longterm brain damage sustained by fighters. The October 28th bout between Tye Fields and Bruce Seldon is an example of a fight that should not have happened. Seldon was stopped in the first round by Mike Tyson in 1996, courtesy of what some observers thought was a phantom punch. He returned to the ring in 2004 and hadn't fought since being knocked out by Gerald Nobles seventeen months ago. Seldon weighed 219 pounds when he fought Tyson. For Fields, he tipped the scales at 262. He was knocked out in the second round, after which Jesse Reid (Fields's trainer) said that Seldon "quit like a dog." John Bailey, a NSAC commissioner, expressed dissatisfaction with Seldon's effort and declared, "He won't fight here again as far as I'm concerned." Bailey also said that it was "a close call" as to whether Seldon should receive his $10,000 purse. That's hypocrisy. Seldon did exactly what he was expected to do.

(10) A significant percentage of fighters who compete in Nevada speak only Spanish. If the ring doctor doesn't speak Spanish, there should be a translator in the corner and in the dressing room afterward. And that doesn't mean a trainer or manager who will say that the fighter is "fine" whether he is or not.

(11) The NSAC accepts out-of-state medicals that it has reason to believe are phony. This is part and parcel of a larger problem in that the commission knowingly accepts false bout agreements and other false documents that are filed by promoters. Under Nevada law, a person who knowingly procures or offers a false document for filing in any public office is guilty of a category C felony punishable by a minimum of one year and a maximum of five years in prison.

(12) The NSAC has failed to thoroughly examine several serious medical incidents, when a real inquiry might have led to greater understanding by the physicians involved and improved medical protocols for the commission.

It's very difficult for a state athletic commission to properly handle all of the medical issues that arise in boxing. Part of the problem lies with the fighters and their camps. When a fighter undergoes his pre-fight physical, he rarely acknowledges injuries sustained in sparring or otherwise. Also, there are many unanswered questions with regard to what causes a subdural hematoma and other forms of brain damage. Clearly, it's not just the force of the blow. If it were, fighters like Mike Tyson and George Foreman would have a string of fatalities on their record.

Also, it should be noted that Nevada is not alone in being plagued by the above-referenced issues. But the Nevada State Athletic Commission is uniquely suited to find answers to these and other questions and properly regulate the medical aspects of boxing. Unlike most states, Nevada derives a huge amount of revenue from boxing. The resources are there to do the job right. But as Greg Sirb (past president of the Association of Boxing Commissions and director of the Pennsylvania Athletic Commission) recently observed, "Pennsylvania regulates a sport; Nevada regulates a business." To that, one can add the thoughts of Kevin Iole, who wrote last month in the Las Vegas Review Journal, "For years, the state's elected officials have ignored the issue of boxer safety."

As if to prove Iole's point, Governor Guinn made his contribution to the debate last week when he removed Flip Homansky from the Nevada State Athletic Commission. It's unlikely that Dr. Homansky's replacement will push as aggressively (and it certainly won't be as knowledgeably) for the enforcement of rules and regulations and new medical initiatives to protect fighters. But that's what happens in an environment where some people are more concerned with power politics than they are with health and safety.